33 replies to this topic

[Jim Ohara]

What parts of the bill do you disagree with Mike? I tried to read the Wiki entry but it seems to be about a funding process that I'm not familiar with. I can see there's layoffs as part of the bill, but I'm not sure who or where. can you help me out?

[Mike]

Short points, as am on the iPhone:
- the Tories and the Lib Dems both campaigned on the promise to stop top-down reforms of the NHS, to allow the Service to concentrate not on organisational issues, but on service delivery. They have broken that promise and instead instituted the biggest structural reform of the NHS since its foundation.
- At the same time, having promised to ring-fence the NHS budget and not impose any cuts, the Government have demanded £20bn of savings by 2015, equalling a 4-5% saving in the total NHS budget every year for five years. That is the biggest cost-cutting exercise the NHS has ever been asked to carry out. Delivering efficiency savings while the ground is constantly changing underfoot results both in inefficiency, and decreased quality of care
- The Act encourages fragmentation of delivery of care, prioritising individual profit margins of 'Any Willing Provider' for services over providing the best package of care centred around the patient. Those most at risk from fragmentation of care are the most vulnerable members of our society.
- The Government's own assessment of the risks involved in implementing the Act highlight that the fragmented NHS that will result will be less able to provide high quality emergency care, particularly in response to major level incidents.
- GPs are being forced into a role that the majority of them do not want to carry out; that of managers and accountants. There are ways to improve clinician's involvement in management level decisions and maximise clinical input without setting the GPs into roles they have not been trained to do. When the new Commissioning Groups fail, the expectation is that private companies will move in to take over the role of the GPs.
- Hospitals, now Foundation Trusts, are dependent on turning profit to survive. Non-profitable hospitals will, for the first time, be allowed to fail. To allow hospitals to maximise their profits, the Act permits revenue generated from private practice in NHS hospitals to rise from an average of 4% to 49%.
- not all services provided by the NHS are profitable. The Act encourages provision of key services which maximise return to the shareholders of the 'Any Willing Providers' while leaving non-profitable services - often vital, core services - to themselves. There is an implicit allowance within the Act for the development of a two-tier NHS, where access to the best care is predicated not on clinical need, but on ability to pay above the odds.
- there is no good evidence that shifting a healthcare service to this model actually improves overall costs; in fact, it tends to drive up total costs as the profitable areas, which currently subsidise the non-profitable areas, are hived off leaving the non-profitable areas no choice but to increase their own costs to cope. The rich get richer, while the poorer struggle to be able to pay for additional services; the evidence is that competition improves profit margins, not quality of care.

[craggy]

What would it do to a government to let thousands of people flout the law in full glare of the media spotlight?

what, like MPs and bankers?

[Jim Ohara]

Thanks very much Mike - hope your thumbs weren't worn out typing that. Sounds like they're going to screw the entire system up. I wonder how many non NHS people can understand what the impact will be.

[jamon g]

Mike, don't want to be too offensive, but for a bunch of people who are recognised as some of the smartest in the country, it seems pretty stupid that all you can think of as industrial action is a strike.
I'm not a brain surgeon, but even I can work out that there are heaps of really effective ways for health staff to affect change rather than crying about it.
Here's a few - strict adherence to work contracts: 8 hours a day, no overtime, no double shifts.
Strict adherence to work policies: there are plenty of times where shortcuts in patient care are taken due to budgetary reasons, usually minor such as changing sheets every second day etc etc. you guys know the ins and outs. Use the more expensive stent etc.
Removal of moral restriction on script use: scripts are free on the nhs yeah? well moral restrictions to junkies aside, no reason not to have a week or two of non questioning of methadone or amphetamine requirements.

Basically, you can do so many things which force the removal of the bill without having to break a sweat. don't even make it industrial policy, just unionise the activity. the budget is the bottom line, give them a billion dollar blowout in a week and make them realise the efficiencies medical staff build in to their practice which can easily be taken away.

[Mike]

The BMA have been discussing the shape of any industrial action for months now Jamon; believe me, those options, and many others were talked about.

Jim, cheers. A lot of people within the NHS took a long time to come to grips with exactly what the Bill was proposing and where it looked it would head to - that's reflected in part in the time it took the major medical representative groups to come around to outright opposition. Understanding how the NHS works isn't easy and I agree that a large part of the problem has been that people have struggled to realise the implications of what has just been passed into law.

[jamon g]

well get on with it then!

[David Meadows]

The NHS is an amazing thing. It lumbers and creaks a bit but when it has to it is capable of doing the most miraculous things. Every failing in it I see, every way we could do something a bit better, pales into insignificance when I look at the alternative. It is absolutely something worth fighting for, before it's too late.

Mike, I agree with everything you wrote in your reply to me, particularly this last paragraph.

I still think this strike action at this time would be a bad idea. It will lose you a lot of good will. And it doesn't matter whether it is all stage-managed by No. 10 or not -- the man in the street won't think about that, he will just see highly-paid (in his perception) doctors striking over money, and he will not come down on your side.

[Mike]

I haven't said what my side is when it comes to striking over pensions. I haven't decided which way I'm going to vote in the ballot yet, let alone what I'll do if the vote is for industrial action. Public perception is clearly going to be key.

What is important is to make sure that people understand what the Government does not want them to - that these are two separate issues. There are complex political games going on - there's another gambit in the FT today for example - and I honestly believe a large part of the Government's strategy, as with pasties and petrol to distract from cash for policies, is to create illusions of equivalence where there are none.

You can disagree with the argument that medical staff feel they are entitled to the pension arrangements we have been promised all along while still agreeing with the separate argument that the NHS Act is a dangerous threat to the principles of the NHS in England. Don't let yourself, or other people, believe that doctors' opposition to the Act has anything to do with pensions; it does not.

You asked what I have done about the Bill/Act; what have you done?

[Christian U]

You asked what I have done about the Bill/Act; what have you done?

That's a fair point, isn't it? This doesn't just affect the doctors (in fact, they'll be among the least affected, in some ways) but everyone living in the UK.



By the way, I can't strike. There's a level of government official/civil servant that means you can't ever go on strike. Among these are teachers, policemen, judges and some clerk jobs and the like. If you're somewhere higher up you're in public administration, it means you're probably a "Beamter", which means you can't go on strike. Of course, it also means you can't be fired (huge problem where teachers are concerned, of course) and have other advantages... I think this is a remainder of a Prussian administrative system or something.

Edited by Christian U, 31 March 2012 - 01:52 PM.

[Ben the Obiwomble]

You seem to be assuming your man in the street David is an idiot who simply believes at face value everything the government tells him - I'm not convinced of that.

People do and will draw their own conclusions, quite a few will go by what their own GP is doing - and a smartly presented reasoning for why a partial suspension of services in clear, accessible English may sway patients to back the GP!

The problem I have with how reorganisation is done in this country is that it is, invariably, always an adversarial process with one clear end: Sacking people for weak reasons. If reorganisation was done with a different ethos, say that of working with the people in the organisation being changed, in order to make it better and do more with the resources it has, with appropriate use of either public or private sector methods as needed, then it would be a different matter. Thus, under such an ethos, staff would not have to be consumed with worry about losing their jobs because the job will remain, there will always be work to be done in the healthcare sector. The presentation shouldn't be: We've now delivering the same level of services with X people and cut Y amount. It should be: We have kept staffing stable but are doing everything we did before better and doing these new services of A, B, C etc..

Working with people is far easier, less costly and will deliver better results but it is not suited to a political model that is addicted to conflict to the same degree as a crystal meth addict! (Though I'm likely guilty of hyperbole on this last bit.)

[Todd Gross]

"The action we will be asking members to take will be to provide urgent and emergency care only for a period of 24 hours. Doctors scheduled to work would need to go to their usual workplaces and undertake some but not all of their usual duties. Where safe to do so, non-urgent clinical work, such as many routine procedures and appointments, would be postponed.

I voted against striking. I think there is simply too much risk with patient's lives. During the course of the strike, something that may seem non-critical on the surface may actually be quite serious. Because it was not attended to in a timely matter, it could have deadly consequences.

This is an extreme example of something that might happen: Woman dies in jail after refusing to leave St. Louis hospital

If doctors, nurses, staff and other supporters want to protest in front of Parliament or wherever, I have no issue with that. But striking could endanger innocent people and isn't that a violation of the Hippocratic Oath?

[Mike]

The industrial action, a limited form of strike, in the UK by doctors is tomorrow. Any patient whose problem is urgent or an emergency - or any where there is doubt - will be seen. The level of care will be far higher than on any normal weekend day, and far far higher than it was on the recent 4 day bank holiday weekend the Government so generously gave us all for the Jubilee. Don't automatically believe everything you see or hear about doctors, pay and pensions; there are a lot of lies flying around. The information from the BMA relating to the strike is here. Very few doctors are on anywhere near the £110K salaries the tabloids are banding around. Doctors pay MORE into the pension fund than we take out of it - the UK Treasury makes a £2bn profit from us every year. This Government has done very little to earn trust; I hope that you know your doctors well enough to know that very few of us went into medicine because we wanted to make money. Medicine in the UK remains a vocation first and foremost, people committed to a shared ideal of doing the best for our patients with the resources we have. If we'd wanted to make money we'd have done something else, and likely earned more, worked less hard, with less disruption to the normal fabric of our lives.

If you can, support us tomorrow. If you don't, please don't believe everything that is said about us without questioning it.

[Christian U]

The industrial action, a limited form of strike, in the UK by doctors is tomorrow. Any patient whose problem is urgent or an emergency - or any where there is doubt - will be seen. The level of care will be far higher than on any normal weekend day, and far far higher than it was on the recent 4 day bank holiday weekend the Government so generously gave us all for the Jubilee. Don't automatically believe everything you see or hear about doctors, pay and pensions; there are a lot of lies flying around. The information from the BMA relating to the strike is here. Very few doctors are on anywhere near the £110K salaries the tabloids are banding around. Doctors pay MORE into the pension fund than we take out of it - the UK Treasury makes a £2bn profit from us every year. This Government has done very little to earn trust; I hope that you know your doctors well enough to know that very few of us went into medicine because we wanted to make money. Medicine in the UK remains a vocation first and foremost, people committed to a shared ideal of doing the best for our patients with the resources we have. If we'd wanted to make money we'd have done something else, and likely earned more, worked less hard, with less disruption to the normal fabric of our lives.

If you can, support us tomorrow. If you don't, please don't believe everything that is said about us without questioning it.

Hope you're having a good and successful day with this, Mike.